Quick answer
If you have CHAMPVA, you may be able to receive care at a VA health facility through the CHAMPVA In-House Treatment Initiative (CITI).
CITI is not available at every VA facility or for every service. Under 38 CFR § 17.270, participating VA medical facilities may provide CHAMPVA services on a resource-available basis to CHAMPVA beneficiaries who are not also eligible for Medicare. VA's current CITI guidance adds that:
- VA covers the entire cost of care and services you actually receive through CITI;
- the types of care available depend on the local facility;
- other health insurance may affect whether you can use CITI; and
- if the VA facility cannot provide the care you need, it may refer you to a community provider, where you may have to pay part of the cost.
The practical rule is simple: check directly with the VA health facility before you rely on CITI for an appointment or service.
What is CHAMPVA CITI?
CITI is a CHAMPVA pathway that allows participating VA medical facilities to treat CHAMPVA beneficiaries when the facility has available space and resources.
That makes CITI different from ordinary CHAMPVA care from a civilian provider. It is also different from a Veteran's own VA health care enrollment.
The regulation defines CITI as an initiative under which participating VA medical facilities provide medical services and supplies to qualifying CHAMPVA beneficiaries, subject to the availability of space and resources. In other words, having CHAMPVA does not create a guaranteed right to receive every covered service at a VA facility.
For a broader overview of the benefit, see What CHAMPVA Is and How It Works.
Who can use CITI?
A CHAMPVA beneficiary generally needs all of the following to line up before using CITI:
- You are enrolled in CHAMPVA.
- The VA facility participates in CITI.
- The facility has the space, staff, and resources for the care you need.
- You are not eligible for Medicare.
- Any other health insurance you have does not prevent CITI use at that facility.
The last point is intentionally facility-specific. VA's current guidance says other health insurance may affect CITI eligibility. Do not assume that having other coverage automatically allows or automatically blocks CITI. Ask the local facility to review your situation.
The Medicare rule is different from ordinary CHAMPVA eligibility
One of the most important CITI rules is easy to miss:
If you are eligible for Medicare, you cannot receive care through CITI.
That does not mean Medicare eligibility always ends CHAMPVA itself. Many beneficiaries keep CHAMPVA as secondary coverage after becoming Medicare-eligible when they meet the applicable Medicare requirements. But CITI has its own restriction: the CITI pathway is for CHAMPVA beneficiaries who are not also eligible for Medicare.
If your Medicare status has recently changed, tell the VA facility before scheduling CITI care.
For help separating these programs, see CHAMPVA vs. TRICARE vs. VA Health Care vs. VA Community Care.
Does every VA medical center offer CITI?
No. CITI depends on local participation and available resources.
VA directs beneficiaries to contact the local VA health facility to find out:
- whether that facility participates in CITI;
- whether you are eligible to use CITI there; and
- which services are currently available.
Even at a participating facility, the available care can differ from one location to another. A service that one VA facility can provide through CITI may not be available through CITI at another facility.
This is why a facility's general list of medical services is not enough by itself. You should confirm that the specific service is available through CITI for CHAMPVA beneficiaries.
How much does CITI care cost?
VA states that it covers the entire cost of care and services you receive through CITI.
That is different from ordinary community CHAMPVA care, where deductibles, cost sharing, other-insurance coordination, and allowable-amount rules may apply.
The distinction matters if the VA facility cannot provide the service itself. VA says the facility may refer you to a local provider in its community care network. If that happens, you may need to pay part of the cost for the community care.
So before accepting an outside referral, ask how the care will be billed and what CHAMPVA cost sharing may apply. Do not assume that the no-cost CITI rule follows the referral outside the VA facility.
If you instead need to find a civilian provider on your own, see Does CHAMPVA Have a Provider Network?.
What kinds of services can you get through CITI?
There is no single nationwide CITI service menu that applies identically at every participating location. VA says the types of care available through CITI depend on the local facility.
A facility may have capacity for some services and not others. Availability can also change as VA resources and Veteran-care demand change.
VA's current CHAMPVA care guidance also notes that certain advance-approval rules work differently for care delivered through CITI. For example, it states that medical equipment or mental health care received through CITI does not need CHAMPVA approval first.
For the broader preauthorization rules outside this CITI-specific context, see Which CHAMPVA Services Require Preauthorization?.
What happens if the VA facility cannot provide the care?
VA says a participating facility that cannot provide the care you need may refer you to a local provider in the community care network.
That does not mean the outside visit is still CITI care. VA specifically warns that you may have to pay part of the cost for care delivered by the community provider.
Before the outside appointment, verify:
- who is arranging the referral;
- which provider you are being sent to;
- whether the provider has the information needed to bill CHAMPVA;
- whether any separate authorization requirement applies; and
- what deductible or cost share may apply outside the VA facility.
The next step should be based on the actual referral and billing arrangement, not simply on the fact that the process started at a VA facility.
How to check whether your local VA facility participates
Use VA's Find VA Locations tool to identify the health facility you want to contact.
Then ask the facility these questions:
- Do you currently participate in CHAMPVA CITI?
- Can you verify that I am eligible to use CITI at this facility?
- Is the specific service I need available through CITI?
- Does my other health insurance affect CITI eligibility here?
- How do I schedule the service through CITI?
- If you cannot provide the service, what happens next and how would outside care be billed?
VA's CITI page specifically directs beneficiaries to contact the local VA health facility to confirm participation and eligibility.
CITI is not the same as ordinary VA health care
CITI uses VA facilities, but it remains a CHAMPVA program.
A CHAMPVA beneficiary using CITI should not assume that the rules for a Veteran enrolled in VA health care automatically apply. Likewise, a Veteran's VA Community Care eligibility and referral rules are a different system from a CHAMPVA beneficiary's CITI access.
When speaking with a VA facility, say that you are calling about CHAMPVA CITI. That helps staff distinguish the request from Veteran enrollment, Veteran Community Care, or ordinary civilian CHAMPVA billing.
Before your first CITI appointment
A short verification checklist can prevent avoidable surprises:
- Confirm your CHAMPVA enrollment is active.
- Confirm the facility currently participates in CITI.
- Tell the facility if you have other health insurance.
- Tell the facility if you are or have become eligible for Medicare.
- Confirm the exact service is available through CITI.
- Ask how scheduling works for that service.
- Ask what happens if the facility cannot provide the care.
- Recheck the billing arrangement if care will occur outside the VA facility.
CITI can be a valuable way to receive CHAMPVA care at a VA facility, but access is local and resource-dependent. Confirming those details before the visit is more reliable than assuming every VA facility offers the same CITI services.